Presentation, Treatment Response and Short-Term Outcomes in Paediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS).
Presentation, Treatment Response and Short-Term Outcomes in Paediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS).
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DOI：
10.3390/jcm9103293
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发表时间：
2020-10-14
影响因子：
3.9
通讯作者：
Hedrich CM
中科院分区：
文献类型：
--
作者：
Felsenstein S;Willis E;Lythgoe H;McCann L;Cleary A;Mahmood K;Porter D;Jones J;McDonagh J;Chieng A;Varnier G;Hughes S;Boullier M;Ryan F;Awogbemi O;Soda G;Duong P;Pain C;Riley P;Hedrich CM
新型严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）是导致2019冠状病毒病（COVID-19）的病原体。虽然大多数儿童和年轻人出现轻微症状，但最近的报告表明，一种与SARS-CoV-2 （PIMS-TS）暂时相关的新型儿科炎症性多系统综合征。病例定义和分类是初步的，治疗是经验性的，疾病相关的结果尚不清楚。在这里，我们报告了29名PIMS-TS患者，他们在2020年3月至6月期间在英国西北部被诊断、入院和治疗。与国际上观察到的模式一致，在英国人群中出现covid -19样症状最初激增后约4周，病例达到高峰。临床症状包括发热（100%）、皮疹（72%）、心血管受累（86%）、结膜炎（62%）和呼吸受累（21%）。部分患者临床特征部分类似川崎病、中毒性休克综合征和细胞因子风暴综合征。男性（69%）、黑人、亚洲和其他少数族裔（BAME, 59%）的比例过高。所有患者均采用免疫调节治疗，包括静脉注射免疫球蛋白（IVIG）、皮质类固醇和细胞因子阻滞剂。值得注意的是，单独接受IVIG治疗的患者中有32%进入了缓解期。其余患者需要额外的治疗，通常是皮质类固醇，只有两名患者分别接受TNF抑制和IL-1阻断治疗。另一名患者接受IL-1抑制作为主要治疗，并伴有快速和持续的缓解。需要随机和前瞻性研究来调查治疗的有效性和安全性，特别是考虑到在未来的COVID-19浪潮中，IVIG的资源可能会因高需求而耗尽。
The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the pathogen responsible for Coronavirus Disease 2019 (COVID-19). Whilst most children and young people develop mild symptoms, recent reports suggest a novel paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Case definition and classification are preliminary, treatment is empiric and disease-associated outcomes are unclear. Here, we report 29 patients with PIMS-TS who were diagnosed, admitted and treated in the English North West between March and June 2020. Consistent with patterns observed internationally, cases peaked approximately 4 weeks after the initial surge of COVID-19-like symptoms in the UK population. Clinical symptoms included fever (100%), skin rashes (72%), cardiovascular involvement (86%), conjunctivitis (62%) and respiratory involvement (21%). Some patients had clinical features partially resembling Kawasaki disease (KD), toxic shock syndrome and cytokine storm syndrome. Male gender (69%), black, Asian and other minority ethnicities (BAME, 59%) were over-represented. Immune modulating treatment was used in all, including intravenous immunoglobulin (IVIG), corticosteroids and cytokine blockers. Notably, 32% of patients treated with IVIG alone went into remission. The rest required additional treatment, usually corticosteroids, with the exception of two patients who were treated with TNF inhibition and IL-1 blockade, respectively. Another patient received IL-1 inhibition as primary therapy, with associated rapid and sustained remission. Randomized and prospective studies are needed to investigate efficacy and safety of treatment, especially as resources of IVIG may be depleted secondary to high demand during future waves of COVID-19.
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影响因子：
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